title: Long-term effects of neovaginal reconstruction with sigmoid loop technique on sexual function and self image in patients with gynecologic malignancies: results of a prospective study.
abstract: OBJECTIVE
  We evaluated the long-term results of sigmoid vaginoplasty in women with gynecologic malignancies after radical pelvic surgery, with specific focus on safety and effects of the procedure on patients' sexuality and self image.
  
  
  METHODS
  This prospective study included women with gynecologic malignancies who underwent partial or complete colpectomy as part of the cancer treatment. In all cases a pedicled sigmoid loop was used for the neovaginal reconstruction. Systematic clinical examination was performed and validated questionnaires about sexuality (Female Sexual Function Index), quality of life (SF-12) and susceptibility to depression (ADSk-15) were answered by all patients at the earliest 6 months after vaginoplasty.
  
  
  RESULTS
  Seven patients with sigmoid vaginoplasty, recruited between 11/2003 and 02/2008, were evaluated in the present analysis. Mean patients age was 48+/-8.49 years. Mean neovaginal length was 6.4 cm (range: 2-12 cm). The mean Female Sexual Function Index (FSFI)-score of all patients was 16.6+/-12.6. In the subset of sexually active patients the mean FSFI-score was 22.5+/-9.4 higher. Regarding early operative morbidity and complications, sigmoid vaginal reconstruction appears to be a safe procedure, though in a long-term assessment 85% of the patients developed a vaginal stenosis with the need for operative bougienage.
  
  
  CONCLUSIONS
  The vaginal reconstruction using a sigmoid loop is a safe and well accepted procedure in patients with gynecologic malignancies. However lower sexuality scores seem to be achieved than in non-cancer patients after equivalent vaginoplasty. Cancer-related physical and psychological comorbidity seem to have negative effects on the overall outcome and patient's satisfaction.
authors.affiliation: Department of Gynecology and Obstetrics, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany. christina.fotopoulou@charite.de
authors.forename: Christina
authors.initials: C
authors.lastname: Fotopoulou
authors.forename: Ulf
authors.initials: U
authors.lastname: Neumann
authors.forename: Christine
authors.initials: C
authors.lastname: Klapp
authors.forename: Werner
authors.initials: W
authors.lastname: Lichtenegger
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012649:Self Concept; D012725:Sexual Behavior; D019529:Sexuality; D016896:Treatment Outcome; D014621:Vagina / Q000502:physiology / Q000601:surgery*